Keywords
Gut microbiota
Gut–ovary axis
Acupuncture
Immune inflammation
Submitted : 2025-06-08
Accepted : 2025-06-23
Published : 2025-07-08
Abstract
Gut microbiota dysbiosis can induce chronic low-grade inflammation and disrupt metabolic homeostasis and intestinal barrier function, thereby impairing ovarian function and contributing to the development of polycystic ovary syndrome (PCOS). Acupuncture, as a traditional Chinese medicine (TCM) therapy, has been shown to regulate the gut microbiota and modulate multiple cytokines, thereby exerting beneficial effects on ovarian function. Guided by the TCM theories of organs and meridian systems, this study integrates the physiological and pathological correlations between the spleen-stomach-intestine system and the ovary, along with the interconnections of meridians. Taking the gut-ovary axis mediated by intestinal microbiota as a key link, we aim to elucidate the mechanism by which acupuncture improves PCOS by modulating gut microbiota. Acupoint selection is based on the principle of restoring intestinal microbial balance, providing a novel approach to the clinical diagnosis and treatment of PCOS from the perspective of the gut-ovary axis.
References
Froment D, Plotton I, Giulivi C, et al., 2022, At the Crossroads of Fertility and Metabolism: The Importance of AMPK-Dependent Signaling in Female Infertility Associated with Hyperandrogenism. Human Reproduction (Oxford, England), 37(6): 1207–1228.
Jin L, Wu X, Zhang C, et al., 2022, Changes in the Prevalence of Polycystic Ovary Syndrome in China Over the Past Decade. The Lancet Regional Health. Western Pacific, 25: 100494.
Li M, Chi X, Wang Y, et al., 2022, Trends in Insulin Resistance: Insights into Mechanisms and Therapeutic Strategy. Signal Transduction and Targeted Therapy, 7(1): 216.
Dong Y, Yang S, Zhang S, et al., 2025, Modulatory Impact of Bifidobacterium longum subsp. longum BL21 on the Gut-Brain-Ovary Axis in Polycystic Ovary Syndrome: Insights into Metabolic Regulation, Inflammation Mitigation, and Neuroprotection. mSphere, 10(2): e0088724.
Zeng G, Miao Y, Li P, et al., 2023, Correlation Between the Gut–Ovary Axis and Polycystic Ovary Syndrome Based on the Theory of “Spleen Governing Transportation and Transformation”. Modern Clinical Traditional Chinese Medicine, 30: 89–93.
Chen Y, Xing L, Zhao R, et al., 2025, Clinical Efficacy of Acupuncture Based on Tonifying the Spleen and Draining Dampness at Different Phases in Treating Insulin Resistance in Polycystic Ovary Syndrome with Spleen–Kidney Deficiency, and Its Association with Serum Inflammatory Factors. World Science and Technology–Modernization of Traditional Chinese Medicine, 27: 227–234.
Zhou L, Ni Z, Cheng W, et al., 2020, Characteristic Gut Microbiota and Predicted Metabolic Functions in Women with PCOS. Endocrine Connections, 9(1): 63–73.
Elkafas H, Walls M, Al-Hendy A, et al., 2022, Gut and Genital Tract Microbiomes: Dysbiosis and Link to Gynecological Disorders. Frontiers in Cellular and Infection Microbiology, 12: 1059825.
Corrie L, Awasthi A, Kaur J, et al., 2023, Interplay of Gut Microbiota in Polycystic Ovarian Syndrome: Role of Gut Microbiota, Mechanistic Pathways and Potential Treatment Strategies. Pharmaceuticals (Basel, Switzerland), 16(2): 197.
Okumura R, Takeda K, 2024, The Role of the Mucosal Barrier System in Maintaining Gut Symbiosis to Prevent Intestinal Inflammation. Seminars in Immunopathology, 47(1): 2.
Pietrangeli P, Corpetti C, Seguella L, et al., 2021, Lathyrus sativus Diamine Oxidase Reduces Clostridium difficile Toxin A-Induced Toxicity in Caco-2 Cells by Rescuing RhoA-GTPase and Inhibiting pp38-MAPK/NF-κB/HIF-1α Activation. Phytotherapy Research: PTR, 35(1): 415–423.
Neurath M, Artis D, Becker C, 2025, The Intestinal Barrier: A Pivotal Role in Health, Inflammation, and Cancer. The Lancet. Gastroenterology & Hepatology, 10(6): 573–592.
Yue F, Xing L, Wu S, et al., 2022, Constant Light Exposure Alters Gut Microbiota and Short-/Medium-Chain Fatty Acids and Aggravates PCOS-Like Traits in HFD-Fed Rats. Obesity (Silver Spring, Md.), 30(3): 694–706.
Zhang D, Jian Y, Zhang Y, et al., 2023, Short-Chain Fatty Acids in Diseases. Cell Communication and Signaling: CCS, 21(1): 212.
Xue H, Hu Z, Liu S, et al., 2024, The Mechanism of NF-κB-TERT Feedback Regulation of Granulosa Cell Apoptosis in PCOS Rats. PloS One, 19(10): e0312115.
Vincenzo F, Gaudio A, Petito V, et al., 2024, Gut Microbiota, Intestinal Permeability, and Systemic Inflammation: A Narrative Review. Internal and Emergency Medicine, 19(2): 275–293.
Ishikawa H, Goto Y, Hirooka C, et al., 2024, Role of Inflammation and Immune Response in the Pathogenesis of Uterine Fibroids: Including Their Negative Impact on Reproductive Outcomes. Journal of Reproductive Immunology, 165: 104317.
Bustamante J, Dawson T, Loeffler C, et al., 2022, Impact of Fecal Microbiota Transplantation on Gut Bacterial Bile Acid Metabolism in Humans. Nutrients, 14(24): 5200.
Qi X, Yun C, Sun L, et al., 2019, Gut Microbiota-Bile Acid-Interleukin-22 Axis Orchestrates Polycystic Ovary Syndrome. Nature Medicine, 25(8): 1225–1233.
Wang J, Yin T, Liu S, 2023, Dysregulation of Immune Response in PCOS Organ System. Frontiers in Immunology, 14: 1169232.
Matveichuk O, Ciesielska A, Hromada-Judycka A, et al., 2024, Flotillins Affect LPS-Induced TLR4 Signaling by Modulating the Trafficking and Abundance of CD14. Cellular and Molecular Life Sciences, 81(1): 191.
Li J, Dan W, Zhang C, et al., 2024, Exploration of Berberine Against Ulcerative Colitis via TLR4/NF-κB/HIF-1α Pathway by Bioinformatics and Experimental Validation. Drug Design, Development and Therapy, 18: 2847–2868.
Zhu Y, Yin Y, Xu H, et al., 2025, Effects of Acupuncture on the HPO Axis and the FSH/cAMP Signaling Pathway in Early-Aging Rats. Chinese Acupuncture & Moxibustion, 45: 200–208.
Szeliga A, Rudnicka E, Maciejewska-Jeske M, et al., 2022, Neuroendocrine Determinants of Polycystic Ovary Syndrome. International Journal of Environmental Research and Public Health, 19(5): 3089.
Yu Z, Qin E, Cheng S, et al., 2022, Gut Microbiome in PCOS Associates to Serum Metabolomics: A Cross-Sectional Study. Scientific Reports, 12(1): 22184.
Yang X, Wang M, Wang X, et al., 2023, Effects of Catgut Embedding Combined with Auricular Point Therapy on Infertility in Obese Women with Polycystic Ovary Syndrome and Its Impact on Gut Microbiota and Glucose-Lipid Metabolism. Chinese Journal of Human Sexuality, 32: 72–76.
Li D, Li Y, Wang X, 2021, Effects of Acupuncture Combined with Traditional Chinese Medicine on Gut Microbiota, Glucose-Lipid Metabolism, and Inflammatory Cytokines in Patients with Obese-Type Polycystic Ovary Syndrome. Journal of North Sichuan Medical College, 36: 1280–1285.
Zhang F, Ma T, Tong X, et al., 2022, Electroacupuncture Improves Metabolic and Ovarian Function in a Rat Model of Polycystic Ovary Syndrome by Decreasing White Adipose Tissue, Increasing Brown Adipose Tissue, and Modulating the Gut Microbiota. Acupuncture in Medicine, 40(4): 347–359.
Bai H, Gu R, Chen L, et al., 2021, Electroacupuncture Interventions Alleviates Myocardial Ischemia Reperfusion Injury Through Regulating Gut Microbiota in Rats. Microvascular Research, 138: 104235.
Ding N, Hao X, Zhang Y, et al., 2025, Benign Regulation of Short-Chain Fatty Acids: The Underlying Mechanism of the Beneficial Effects of Manual Acupuncture on Cognitive Ability and the Intestinal Mucosal Barrier in APP/PS1 Mice. Frontiers in Neuroscience, 19: 1509581.
Wang M, Liu W, Ge J, Liu S, 2023, The Immunomodulatory Mechanisms for Acupuncture Practice. Frontiers in Immunology, 14: 1147718.
Xue H, Liu H, Yu D, et al., 2024, Research Progress on Warm Acupuncture in the Treatment of Polycystic Ovary Syndrome. Clinical Medicine Research and Practice, 9: 186–189.
Wu X, Huang G, Li X, et al., 2021, Research Progress on Acupuncture in Regulating Gut Microbiota. Journal of Shanghai University of Traditional Chinese Medicine, 35: 103–108.
Jiang X, Liu J, Zhang Y, et al., 2020, Effects of Cangfu Daotan Decoction Combined with Metformin and Acupoint Catgut Embedding on Immune Function and Gut Microbiota in Obese Patients with Polycystic Ovary Syndrome Infertility. Clinical Misdiagnosis & Mistherapy, 33: 51–56.
Du D, Zhang W, 2025, Exploration of the Academic Connotation of Treating Premature Ovarian Failure from the Liver Meridian Based on the Theory of Meridian-Viscera Correlation. Journal of Guangzhou University of Traditional Chinese Medicine, 42: 140–146.
Liu W, Yang L, Ma S, et al., 2024, Analysis of Zhang Zhongjing’s “Harmonizing Method” in the Treatment of Polycystic Ovary Syndrome. Traditional Chinese Medicine Research, 37: 5–9.
Shen L, Fu X, Zeng Q, et al., 2023, Comparison of the Efficacy of Different Frequency Electroacupuncture in the Treatment of Polycystic Ovary Syndrome Patients with Abdominal Obesity. Acupuncture Research, 48(12): 1266–1273.
Shen L, Chang X, Pan L, et al., 2022, Effects of Electroacupuncture on Hypothalamic NF-κB Signaling Pathway in Insulin Resistance in Rats with Polycystic Ovary Syndrome. Journal of Clinical Acupuncture and Moxibustion, 38: 72–76.
Geng Z, Liu P, Yuan L, et al., 2023, Electroacupuncture Attenuates ac4C Modification of P16 mRNA in the Ovarian Granulosa Cells of a Mouse Model Premature Ovarian Failure. Acupuncture in Medicine, 41(1): 27–37.
Xu M, Guo Y, Chen Y, et al., 2023, Electro-Acupuncture Promotes Gut Motility and Alleviates Functional Constipation by Regulating Gut Microbiota and Increasing Butyric Acid Generation in Mice. Journal of Integrative Medicine, 21(4): 397–406.